Key messages

• Spontaneous hemothorax is uncommon.

• Small-volume aspiration and analysis precede complete drainage.

• Hypovolemia is life threatening in acute large-volume drainage.

• Arrange for rapid transfusion prior to draining hemothorax.

• Acute massive hemothorax should be managed in an operating area before drainage, where time permits.

• Small-volume hemothorax in a stable patient may lead to a better outcome if managed conservatively rather than repeatedly aspirated or drained.

• Thoracoscopy should only be carried out by experienced personnel.

• Thoracotomy can add to morbidity if carried out by the inexperienced.

• A bag with a valve can be an alternative to an underwater-seal bottle.

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